Table 1.

Challenges and key issues for public understanding and involvement in food policy^a

Challenges	Key issues for public understanding and involvement
Obesity	Our current food system favors the production of animal products and highly refined, calorie-dense foods, rather than the fresh fruits and vegetables, whole grains, and other high-fiber foods important in prevention of obesity and related diseases.
Antibiotic-resistant bacteria	There is a strong consensus among experts that antibiotic use in agriculture contributes to rising drug-resistant infections in humans. An estimated 70% of all antibiotics consumed in the US are used as feed additives for poultry, swine, and beef cattle for nontherapeutic purposes. That is, antibiotics are used to promote growth and to compensate for diseases caused by poor animal husbandry.
Contaminated air, water, and food	Agricultural operations that confine large numbers of livestock to a closed area— concentrated animal feeding operations (CAFOs)—pose a hazard to soil, water, and air quality. Worker and public health concerns related to CAFOs include heavy metals, antibiotic resistance, pathogen bacteria, dust, mold, and volatile gases.
Fossil fuel consumption and climate change	Industrialized agriculture methods are fossil fuel intensive; the US food system accounts for an estimated 10.5% of the nation's energy use and 19% of its fossil fuel consumption. The direct and indirect impacts of climate change on human health are substantial and include heat-wave fatalities, increased incidence of infectious diseases, and exacerbation of respiratory diseases.
Pesticide use	Reducing pesticide use is a key health priority given the many human health problems associated with pesticide exposure, as well as damage to other species.
Racial and ethnic health disparities	Low-income people and people of color face well-documented challenges to obtaining fresh fruits and vegetables and other nutritious foods: either they are not available in the neighborhood or the quality is poor and the price is high. Research shows that the scarcity of healthy foods makes it more difficult for residents of low-income neighborhoods to follow a good diet, compared with people in wealthier communities.

^a Public and political support for sustainable agriculture will not occur without greater awareness and understanding of how our industrialized food system is affecting human and ecological health.

Reprinted with permission from: Sustainable Food Procurement and Agriculture Policy: Making the Case for Health Sector Engagement. In Focus [serial on the Internet]. 2009 Fall;5 [about 4 p]. Available from: www.kpihp.org/publications/docs/5917_Focus5b_Making_v5.pdf.